MEDICARE: KAKODKAR FAMILY MEDICAL CENTER

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1770655011
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KAKODKAR FAMILY MEDICAL CENTER

Provider Business Mailing Address
First Line	:	PO BOX 3297
Second Line	:
City	:	EAST CHICAGO
State	:	IN
Zip	:	46312-8297
Country	:	US
Telephone Number	:	219-924-8458
Fax Number	:

Provider Business Practice Location Address
First Line	:	3700 MAIN ST
Second Line	:
City	:	EAST CHICAGO
State	:	IN
Zip	:	46312-2224
Country	:	US
Telephone Number	:	219-398-3016
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	ARVIND KAKODKAR
Credential	:	M.D.
Telephone Number	:	219-924-8458

Provider Enumeration Date	:	11/14/2006
Last Update Date	:	08/09/2010

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